The emergence of COVID-19, and the country’s response to it, has resulted in positive transformation in some areas of Australian healthcare, but it has also highlighted inequalities and bottlenecks in the healthcare system that could have long lasting effects on health care service provision and patient outcomes.

While the country has not yet reached a post-pandemic phase, it is a good time to reflect on events over the past few months from a wider perspective and consider how these may lead to a change in health care management, planning and delivery going forward.

In general, the response by Australian governments and the broader health sector to the crisis itself is considered to have been good, with Australia achieving a better outcome than in many other countries. Collaboration between states, and public-private agreements have enabled additional capacity to be created, and efforts to expand telehealth during the pandemic has helped ensure continuity of essential services. But vulnerabilities in the supply chain, a need to increase resilience and collaboration between health care, aged care and community care have also emerged.

Has COVID-19 created new opportunities to rebuild or make fundamental changes to the health care system? This is the hypothesis of the Australian Healthcare & Hospitals Association (AHHA), which recently published a report on the issue – Australian Healthcare after COVID-19: An opportunity to think differently.

The AHHA has identified resilience at the centre of forming a modern, sustainable and resilient healthcare system, focussed on health outcomes and capable of absorbing shock. The report has outlined a number of actions the AHHA consider to be necessary, such as; greater transparency and collaboration, greater patient empowerment and a reduction in low and no-value health care.

It also suggests training and education of its workforce, in particular within aged care, better quality of data and more local medical manufacturing are essential to rebuilding a more resilient care and flexible system.

Another report on the issue by PWC Australia, entitled What’s next for Healthcare?, reviews how the momentum created by COVID-19 can be used to ‘reboot’ Australia’s healthcare system, and a number of forces of change that will shape recovery in the healthcare sector have been identified. These include factors such as; collaboration, a better balance between health, economic and social outcomes, agile decision making, sustainability, migration, funding, flexible supply chains, workforce supply and accelerated digitisation.

Already, positive change has taken place. As well as progress in telehealth take up and an increase in use of technology, which can also improve access to healthcare for rural and remote communities, more ICU nurses and other healthcare staff have been recruited and trained. But there is more to do, and PWC’s report looks at the wider perspective, including taxation and economic impact of changes to the healthcare system.

However, what is perhaps missing from the discussions around a resilient healthcare system with the flexibility to respond more effectively to immediate challenges, is the facilities aspect. The use of buildings, facilities and equipment has in many cases needed to be substantially reconfigured, and the fragility of the set-up has been illustrated by recent government announcements and media reports regarding the resumption and then suspension of elective surgery once again, due to an increase in COVID-19 cases.

Although postponing elective surgeries may be, in Premier of South Australia Steven Marshall’s words ‘a reasonable response to surges in hospital demand’, and more urgent cases should naturally be prioritised, the impact this causes is not a sign of a resilient healthcare system.

A healthcare system with built-in resilience and flexibility ensures the continuity of service, and avoids backlogs building up, by implementing solutions within a short space of time.

Looking ahead, there is likely to be a continued period of uncertainty, where there is a continuing need to maintain capacity for COVID-19 patients in case of further outbreaks, while at the same time attempting to address the backlogs in elective surgery and preventative health. The need to keep at least some of the reconfigurations already made to healthcare facilities for the foreseeable future, provides an opportunity for considering what changes need to be made to facilities and physical premises, and to the patient journey, to increase resilience in the longer term.

There could be some benefit in keeping a separation of patient journeys, whether that be a separation between urgent cases and minor injuries and ailments within emergency departments, or between urgent or emergency surgery and elective surgery. Planning for continuity of service in a crisis may need to include a transfer of patients to a different facility in the private or public sector, or the commissioning of temporary buildings and staff.

One positive effect of the pandemic has been the growing awareness of temporary, flexible solutions, and the development of innovative, new solutions, driven by the requirement for additional physical capacity at short notice, and the requirement for the separation or isolation of patients.

Many of the solutions for improving resilience and ‘rebooting’ the healthcare system represent major transformations of a longer-term nature that will take many years to implement.  But in the meantime, ways to accelerate recovery in the Australian healthcare system, such as temporary solutions for dealing with the inevitable backlogs, must be considered.